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. 2025 May 9:59:101700.
doi: 10.1016/j.ijcha.2025.101700. eCollection 2025 Aug.

Multimorbidity increases risk of atrial fibrillation recurrence after cryoballoon ablation

Marieke J H Velt  1 , Colinda van Deutekom  1 , Michelle Lobeek  1 , Michiel Rienstra  1 , Yuri Blaauw  1 , Bart A Mulder  1
Affiliations

Multimorbidity increases risk of atrial fibrillation recurrence after cryoballoon ablation

Marieke J H Velt et al. Int J Cardiol Heart Vasc. .

Abstract

Background and aims: Despite advancements in atrial fibrillation (AF) catheter ablation techniques, atrial arrhythmia recurrence after the procedure remains common. Although individual comorbidities are known to affect ablation outcomes, the role of multimorbidity is unclear. This study aimed to investigate the association between multimorbidity and atrial arrhythmia recurrence after cryoballoon AF ablation.

Methods: The cryoballoon ablation study is a single-center, prospective registry including 349 consecutive patients undergoing cryoballoon AF ablation. The presence of eleven comorbidities was assessed and the population divided into two groups: no multimorbidity (0-1 comorbidity) and multimorbidity (≥2 comorbidities). Clinical follow-up visits combined with 12-lead ECG and 24-hour Holter monitoring were scheduled at 3, 6 and 12 months post-procedure. Cox proportional hazard regression analyses were conducted to assess the association with atrial arrhythmia recurrence. Kaplan-Meier estimates for the cumulative risk of the first recurrence were calculated and plotted.

Results: The mean age was 62 ± 9 years and 123 (35 %) were women. Multimorbidity was present in 184 (53 %) patients. During a median follow-up of 328 [IQR 203-409] days, 114 patients (33 %) experienced atrial arrythmia recurrence within one year after cryoballoon AF ablation. Cox proportional hazard regression analyses, adjusted for age and sex, revealed a significant association between multimorbidity (HR 1.64, 95 % CI 1.12-2.39) and atrial arrhythmia recurrence. Furthermore, hypertension (HR 1.58, 95 % CI 1.01-2.49) and obesity (HR 1.63, 95 % CI 1.09-2.42) were associated with recurrence at one year post-ablation.

Conclusion: In AF patients undergoing cryoballoon AF ablation, multimorbidity was associated with atrial arrhythmia recurrence within one year post-ablation.

Keywords: Comorbidities; Cryoballoon ablation; Multimorbidity; Recurrence.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [The cryoballoon registry reports financial support was provided by Medtronic Inc. Colinda van Deutekom reports financial support was provided by Horizon Europe. Michiel Rienstra reports financial support was provided by Horizon Europe. Michiel Rienstra reports a relationship with Bayer AG that includes: consulting or advisory. Michiel Rienstra reports a relationship with InCarda Therapeutics, Inc. that includes: consulting or advisory. Michiel Rienstra reports a relationship with Netherlands Heart Foundation that includes: funding grants. Michiel Rienstra reports a relationship with ZonMW that includes: funding grants. Yuri Blaauw reports a relationship with Boston Scientific Corporation that includes: funding grants. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.].

Figures

None
Graphical abstract
Fig. 1
Fig. 1
Number of comorbidities in the study population.
Fig. 2
Fig. 2
Overview of comorbidity combinations in the study population.
Fig. 3
Fig. 3
Forest plot of the individual comorbidities and risk of atrial arrhythmia recurrence within 1 year following cryoballoon AF ablation.
Fig. 4
Fig. 4
Multimorbidity and atrial arrhythmia recurrence.
Fig. 5
Fig. 5
Kaplan-Meier curve for the cumulative atrial arrhythmia-free survival within 1 year following cryoballoon AF ablation according to the presence of multimorbidity.
See this image and copyright information in PMC

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